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Quality of risk assessment prior to suicide and homicide

Published online by Cambridge University Press:  02 January 2018

Mohammad Shaiyan Rahman  and
Nav Kapur
Mohammad Shaiyan Rahman
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, and Greater Manchester West Mental Health NHS Foundation Trust, Manchester, email: [email protected]
Nav Kapur
Affiliation:
Psychiatry and Population Health, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Manchester
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Abstract

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The Psychiatric Bulletin , Volume 38 , Issue 1 , February 2014 , pp. 46 - 47
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2014

We are grateful to Large & Nielssen Reference Large and Nielssen1 for their interest in the report from our pilot study, Reference Rahman, Gupta, While, Rodway, Ibrahim and Bickley2 but think they may have misunderstood its main purpose. We wished to investigate the ‘low risk paradox’ – the fact that in the National Confidential Inquiry data, risk is nearly always reported as low prior to suicide and homicide. 3

We agree that risk assessment in people who do not die is of interest but our study was not set up to investigate this. Equally, contradictory risk factors are of interest but our focus was on the risk assessment process itself, not on a tally of risk factors or whether they were the ‘right’ ones. Last, our study was not an investigation of the predictive utility of risk assessment. We are familiar with the low base rate problem and have written about this elsewhere. Reference Kapur4

We would wholeheartedly agree with Large & Nielssen's suggestion that assessments should be compassionate, ethical and needs-focused. However, we would take issue with their objection to risk assessment as a whole – we think it is never futile and can sometimes be life-saving.

References

1 Large, M, Nielssen, O. Look back in anger: flaws in the retrospective evaluation of risk assessment. Psychiatrist 2013; 37: 373.Google Scholar
2 Rahman, RS, Gupta, S, While, D, Rodway, R, Ibrahim, S, Bickley, H, et al. Quality of Risk Assessment Prior to Suicide and Homicide: A Pilot Study. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester, 2013.Google Scholar
3 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Avoidable Deaths: Five Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. University of Manchester, 2006.Google Scholar
4 Kapur, N. Evaluating risks. Adv Psychiatr Treat 2000; 6: 399–406.CrossRefGoogle Scholar
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